Provider Demographics
NPI:1447615729
Name:COOPER, TRACY MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-1066
Mailing Address - Country:US
Mailing Address - Phone:585-957-3981
Mailing Address - Fax:
Practice Address - Street 1:34 W GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1224
Practice Address - Country:US
Practice Address - Phone:585-957-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker